Psychedelic therapy: The patients paying $2k to get high with their doctor

April 29, 2019

Jesse Noakes had been battling his mental health for years when he stumbled across Carlo, a new breed of doctor who promised to change everything.

It’s about 3pm on a Tuesday and I’m in an apartment in Sydney with harbour views.

I can’t see much from where I am, though, lying on a couch with an eye mask covering my eyes and Handel’s Messiah playing through headphones.

A couple of hours earlier I’d been a bit nervous — around the time I swallowed a capsule of MDMA and two grams of powdered magic mushrooms. But I know the apartment’s owner, my therapist, is sitting on the floor across the room, with his dog curled up next to him, and it reassures me, so I lie back and allow the choral voices to swell until they fill my whole awareness, and I go somewhere else.

It wasn’t the first time I’d come to Sydney to spend an afternoon tripping. The first time, I drove across the Nullarbor from Perth to get there in an old ’93 Holden Barina — these days it is a short flight down from Byron. Not as far as Europe or New York, which is where my journey began.

In the middle of 2016 I went to a conference in Amsterdam dedicated to a field of research I’d only just heard about: psychedelic therapy. I told everyone I was attending as a journalist; in reality, I was on the hunt for a therapist of my own.

I flew halfway round the world in uncut desperation. After a decade of therapy and medications, I was as depressed as ever. One airless afternoon in January 2016, I rolled out of bed and pulled up an article I’d seen months earlier about American hospitals giving some patients magic mushrooms for depression and anxiety in clinical studies. Three-quarters showed significant improvements in their mental health.

UNEXPECTED RESEARCH

That wasn’t all. Six placebo-controlled trials using MDMA for people with post-traumatic stress disorder (PTSD) from war and sexual assault found 68 per cent were in complete remission a year after three all-day sessions. After a couple of regular therapy sessions to prepare them, participants would come to a comfortable office and lie down on a sofa with an eye mask and headphones on and take a trip while a pair of therapists sat by their side.

One participant, Ed Thompson, a firefighter from South Carolina, told me his life before the trial “was kind of like a waking nightmare where all of these memories were randomly hitting me”. “There was a part of my brain that was stuck in those moments,” he said. “It was basically a constant panic attack that I lived in, an almost unending panic attack.”

When he enrolled in the trial, he rated 30 points higher than the most severe threshold for PTSD — and after three MDMA sessions, he no longer had PTSD.

“I’m happy again, I’m not numb, I love life, I love my family. I’m able to absorb the good moments and feel the bad ones. I couldn’t be better,” he said.

It was like stepping through a doorway into a secret room. Until now, I’d always thought psychedelics, which are illegal Schedule 9 substances in Australia, like LSD and mushrooms sent you crazy. Suddenly, it sounded like, used responsibly with appropriate therapeutic support, they could be effective ways of regaining sanity.

Patients say they feel a sense of peace like never before. Picture: SuppliedSource:istock

HEADING UNDERGROUND

For several months, I investigated here in Australia. I quickly realised legal clinical trials were off limits. A small organisation called PRISM had been advocating psychedelic research here for years but appeared to have little support for their proposed studies.

At the Amsterdam conference, in between talks like “Brain imaging and depression research with psychedelics” and “MDMA for trauma integration”, I met a therapist I’ll call Carlo (all the names of underground therapists and their clients have been changed in this piece).

I explained how trapped I felt — dead to the world, unsure why it felt so unreal and distant all the time. “Come to New York,” he said. “I’ve got just the thing.”

Underground psychedelic therapy fills the gap left by limited trial spaces and a regular therapy paradigm that doesn’t do the job for many. A Vox article recently called it a “parallel mental health service” in the United States. “This stuff is exploding,” a therapist in California told me last year.

Dr Rick Doblin is the founder of the non-profit Multindisciplinary Association for Psychedelic Studies (MAPS) that has organised most of the research into MDMA therapy in the US. Although he’s spent decades establishing legal studies, he understands why so many people are turning to illegal alternatives.

“We’ve got people in regular therapy who are desperate and stuck. The laws make it impossible for them to access the help they need, so going to underground therapists is perfectly appropriate. However, I’m sad it’s the only option for some people — it means we’ve got to move quickly to legitimise it,” he said.

Ed Thompson is even more effusive. “People like the underground therapist you’re discussing have got to be some of the greatest heroes of our time because of the legal risks, because of the risks to their careers and knowing that it’s gotta be done regardless of stupid bureaucratic red tape.”

Professor Steve Kisley, Chair of the Psychiatrists Group of the Australian Medical Association, is more cautious.

“There are some promising findings, but they are insufficient at this time to advocate general clinical use. While use remains unregulated, there are dangers in terms of side-effects and toxicity from incorrect dosing and impurities in illegal supplies, which could outweigh any clinical benefit. The same would apply to ‘underground therapists’.”

BREAKTHROUGH THERAPY

The clinical research so far has been so promising the US medicines regulator has declared both MDMA and mushrooms “breakthrough therapies”, giving them additional resources to bring to market. But it’ll still be a couple of years before the final phase of trials are completed and psychedelic drugs become a legal therapy option for the first time since the 1960s (when substantial research was conducted, and everyone from Cary Grant to the founder of Alcoholics Anonymous discussed the benefits of therapy with LSD).

In the meantime, researchers and therapists I’ve spoken with across America reckon there are hundreds of facilitators guiding patients through psychedelic experiences. Training varies, and so do prices. I spoke to two therapists in California, both of whom have graduate degrees in psychology — one charges on a sliding scale that starts at $US500 ($A700), the other charges $US2000 ($A2800) per session.

Carlo, my guy in New York, charges up to $1500 for an overnight stay.

TAKING DRUGS TO KICK THE HABIT

Why would people want to fork over a fortnight’s pay to take drugs with their therapist? I asked another of Carlo’s clients, Alba, a New Yorker in his late 20s who has suffered from chronic social anxiety since his teens. Both his parents had abused him growing up — he remembers having his head bashed against heavy oak bed frames when he was just a toddler.

Before he had his first session with Carlo late last year, he was drinking a bottle of vodka every evening to control the crippling paranoia and discomfort he felt at work. Several years ago, after he attempted suicide twice within a week, he vowed he wouldn’t try again until he’d fully exhausted his options. Through a subreddit thread he contacted people who put him in touch with therapists, which led finally to Carlo’s loft.

At one point in his first session with MDMA, he suddenly felt a new sense of safety and love. He asked Carlo for a hug, which he’d never done with his own father. “I don’t like people touching me. I just get really, really tense. But with him, for some reason my guard was down.”

Brain imaging has shown MDMA profoundly deactivates the amygdala, the part of the brain that regulates our fear and anxiety responses and promotes production of oxytocin, known as the “trust hormone”.

After that first session, Alba quit drinking. He’s been sober for five months now, bar a brief relapse after Christmas. He lives in a much larger, lighter apartment, he’s turning up to work on rough days when previously he’d have stayed in bed with a bottle of vodka, and he feels optimistic about his future. “It allows me to look at all those horrible situations in a completely different light.”

Patients report the treatment as being like nothing they’ve ever experienced. Picture: iStockSource:Supplied

Dr Ben Sessa is a British psychiatrist leading a clinical trial in the UK using MDMA to treat alcoholism. All but one of the patients he’s treated so far have stayed sober after their therapy with the drug, Sessa reports. “They talk about ‘I can see the light, I can see the folly of alcohol, and I have no interest in returning to it’,” he said.

Sessa is cautious about therapists recreating his trial underground. “I have no doubt there are some excellent underground therapists who have really good results, but there are also plenty of scare stories of very poor ones. What the underground therapists tend to miss is the importance of the non-drug sessions.”

Post-drug therapy sessions, known as integration, is a crucial tenet of the psychedelic therapy movement. Some of the drug experiences people have are so far outside the realms of their usual experience they need help to make sense of them, says Dr Rick Doblin.

“The idea of a one-dose miracle cure is really dangerous. It requires a lot of work on an ongoing basis,” he said.

NOT A MAGIC BULLET

Of course, nothing works for everyone, all the time. The first two sessions I had using MDMA, with a European doctor I also met in Amsterdam, were underwhelming, and left me feeling disappointed and desperate.

I had some visions, but probably nothing more than you’d expect when you spend all day lying in a dark room with your eyes closed. It was nothing like the breakthrough I’d been hoping for, and after the first session I messaged a friend: “The drugs don’t work.”

I felt more like it was me that didn’t work.

For others, rather than finding nothing, their sessions revealed too much. A friend of mine in California found immediate relief from PTSD during his first MDMA session, but then suffered weeks of black depression afterwards.

Since then, his road has been rocky — while he’s done further sessions with other psychedelics and therapists, he still fights with panic and depression, and uses exercise, lifestyle choices and prescription medication to try to keep the wolf from the door.

Psilocybe cubensis is a species of psychedelic mushroom. Picture: SuppliedSource:Supplied

THE SCENEDOWN UNDER

Maria offers psychedelic therapy from what would normally be the dining room of her ordinary brick bungalow in the forest outside a major Australian city.

A rooster crows outside the window as we chat at her kitchen counter over green tea. She closes the dishwasher as I sit down.

Maria runs both group and individual sessions, with a range of “medicines” — MDMA, psilocybin, ayahuasca. She charges $270 for a group session and $550 for one-on-one — not bad for an intensive seven-hour treatment that carries serious legal risk.

“I try not to think about it,” she tells me when I ask about it.

I’ve spoken to two therapists overseas who’ve been prosecuted for treating patients with psychedelics. Both received suspended sentences, and both continue to work with clients — one now runs a legal psilocybin retreat in Jamaica.

Both Carlo and Maria operate by word of mouth, and besides knowing someone who’s already been, it’s not clear how you’d find one of them.

“I don’t really know,” Maria says. “At the moment it’s just referrals from people that I’ve treated. There’s definitely more interest in psychedelics in the past few years.”

Maria has a client list of more than 600 people — Carlo says he receives about three new inquiries a week, and when I spoke to him recently he’d just flown back to New York after treating four clients in LA.

A member of the team behind the recently announced trial of psilocybin for anxiety and depression in Melbourne said he was aware of perhaps a dozen underground therapists in this country. “But there are probably more, given that most try to keep a very low profile. Some of the therapists keep in touch and share information, but even that’s risky in the current legal climate.”

WHAT NEXT?

Dr Doblin founded MAPS in 1986 to legalise MDMA and has spent three decades of tireless advocacy to get to a point where it’s suddenly foreseeable. He says his quixotic mission is motivated by gratitude.

“I will never repay all the benefits I’ve got from psychedelics. All of this work has still not even paid back for the good I’ve received from these drugs,” he said.

I know how he feels. In Sydney, as the choir reached its rapturous peak, I saw the world as a big, blue blanket, each of us a stick poking into it, like a million tiny tent poles.

Movement from any one stick shifted the tautness and balance of the blanket, weighing down or buoying up every other stick in a contiguous wave. Seeing is believing, as they say, and this was more like a real-life VR experience of a different world. I felt a rapturous sense of connection and possibility.

Jesse Noakes is one of a growing number of people seeking relief in psychedelic therapy. Picture: Peta RoebuckSource:Supplied

It didn’t go away when the drug wore off. For months afterwards, I felt more confident and socially connected than ever before. The world was a lot more fun. I spoke each week to my therapist on the phone. We spent much of those conversations discussing my work, trying to care for traumatised teenagers who had been removed from their families. I found them wildly intense and incredibly energising. “It’s the best therapy I’ve ever done,” I told him, “with the possible exception of coming to Sydney to take mushrooms and MDMA with you.”

Psychedelic therapy is currently illegal in Australia and unregulated use carries significant risks that may outweigh any benefits.